Rastreio, diagnóstico e conduta no Diabetes Mellitus Gestacional (DMG): uma revisão sistemática comparando os diferentes critérios (IADPSG x WHO x outros) e seus impactos nos desfechos perinatais

Abstract

Introduction: Gestational Diabetes Mellitus (GDM) represents a significant challenge in maternal-infant health, with increasing global prevalence. The lack of universal consensus on ideal screening and diagnostic criteria generates variability in clinical practice and potential impact on perinatal outcomes. Objective: To compare GDM screening and diagnostic criteria (IADPSG, WHO and others) and evaluate their impacts on perinatal outcomes. Methods: Systematic review conducted according to PRISMA guidelines, with search in PubMed, Cochrane Library, Embase and LILACS until June 2024. Randomized clinical trials, prospective cohorts and comparative studies evaluating different diagnostic criteria for GDM and its outcomes were included. Results: Among 32 included studies, IADPSG criteria identified 50-65% more GDM cases compared to previous criteria, with consequent increase in interventions, but with 20-30% reduction in adverse outcomes such as macrosomia, shoulder dystocia and pre-eclampsia. WHO-2013 criteria demonstrated intermediate sensitivity, while two-step protocols showed significant variability in detection. Conclusion: IADPSG criteria are associated with higher GDM detection and potential reduction of perinatal complications, although with increased healthcare burden. Criteria choice should consider epidemiological context and available resources.